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Home My WebLink About0309 GREEN DUNES DRIVE - Health 309 Green Dunes Drive Centerville A= 245-028 i N SMEAD No. 53LOR UPC 12543 smead.com • Made in USA aZ' _2 ASSESSms ma No: / No...... 5� PARCEL No:� Fizs.. ko........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Ui!jpv!3u1 Wurkri Towitrnrtinn jhrnfit Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal Syst atg � - t� -�V .. 7 w � -.. Location-Address \or Lot No. Rh/-..T� v/-Z....... ,&----................. ................................•.............................................................•... Owner. Address ( 1��.......- •-•••Qnvs� -J----------------------------- Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.-.---------.--------------- Showers ( ) Cafeteria ( ) a' Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---............. Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..--................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GZq Test Pit No. 2................minutes per inch Depth of Test Pit.--- ............... Depth to ground water........................ P4 ----------------------------------------•--•---.....-----...---....._----•----•-•--•......_.................................................................. ODescription of Soil........................................................................................................................................................................ x ------•.........................•-••-•.......••-••••-- W ---•------------------------------ -------------------------------------------------------------------------• ----- . U Natur air or Alterations—Answer when applicable....-. .....-. ....................l..�.........._... ..T__... .._--•-- ... -------------------- -•--------------------•-------------------------------------------------------•-------- ................................................... Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corn�.. ce h s been issu y board of health. Signed ........ . ..... .:.:...... .. .. .._ . .. . 2?�... ..... re ApplicationApproved By ------- ... -------------- --------_------........................---------------------------- ......J� Application Disapproved for the following reasons- --------------------------- --------------------------- --- --- - ------ - ---- - ------------------------------ .. ................ ................................................................. . . ............................ .... ................................. ............ . . --. --------------- `^ Date Permit No. ..........7S----------V.... ��................ Issued ------------ -s'�3' ,5 ............ Dace 40 i ��---��-- s0 a /FEE....... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uhnpmml Vurkt5 Tvastrurt"inn ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Syst at: .... .. a ')rCamZ Location-Address Lot No. ................ Owner Address ...................CSC\t -------------------------•- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No, of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons.-..-..-----_----. ---.._. Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------- ----------------------•----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width.......--....... Diameter—------. -. -- Depth................ x Disposal Trench—No. .................... Width---................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter..................-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- a Test Pit No. I................minutes per Inch Depth of Test Pit--------............ Depth to ground water.........--............. L%I Test Pit No. 2................minutes per inch Depth of Test Pit....................... Depth to ground water........................ D Description of Soil............................ V .........-•-•-------•-•---•-••--------••-•••---•---... -----� ................... .. ---------- - - - - -----•-•--- -------------- --- • -----•--- ---------•----.....------•--------•-••--•--.......----... . ..------. = - t wee........................... U Nature_oQe airs or Alterations—Answer when applicable----- ---------t —..........�.. U .... C-...... ............. \ -----------...........................................0.................. ............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp 1'ance Is been issu d'by tl3 board of health. Signed .. 1- ._.----- ) ..... ........._.........................;.... ......_.�.�2 3.. as` Dace Application ApprovedBY ....._' ....a ...1i .. Application Disapproved for the following reasons: - ..... .......... .....j,�-,.................................... . .......... 1e ................ ......... .. ............................................................................ ... ..... ...... .. .. ........................ ...................................................... ................ Permit No. -------- -......�.... 5.5'............... Issued ................ .. -' Date...... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (Ilertifirate of V omplianve 1 TO CERU 1 That the Individual Sewage Disposal System constructed ( ) or Repaired ( !/� .. . R��' ller at ...... '.. . � �......... ... .. ...�.��.- .... : -�.�c�y� cS2�i" has been installed in accordance provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------- ,�`_-...57!i'.5---. dated . ..�'; . _... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....._ ............%.:? ......./..V.._...............------------ lnspector ...._..... _................... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T TOWN OF BARNSTABLE No....... -��-�---"•S--•�� FEE..._..._J. ....... !omitrudion �rrmit Permission is hereby granted .._ �_ � ---------------•---------------------------•----------.-•--............._.. to Construct ( )��°r �R�epair (� aIndividual Sewage Disposal System at No...3 !,-j- �Q �,�! � a: .... l 'VI �I C _.._.... .... Street i as shown on the application for Disposal Works Construction Permit No.. .............f.. Dated.�1. 7:��.�.��............... 7 2 y ' ( -i/........................ Board of Health fDATE.........................------- ---•----•--_.......... FORM 36508 HOBBS et WARREN.INC..PUBLISHERS l - LlV No.. Fm:$....3 0. 0 0........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Dhipoiitti Workii Tnntitrnrtinn ramit Application is hereby made for a Permit to Consquct ( ) or Repair (X� an Individual Sewage Disposal System at: ... .6.2..... 1 .1_c�.A. &i.J a h s...�� . ............ -Lot --#..3- -------------------------------------------••- Location-Address or Lot No. Shed l a---A P-a_n_dxea................................................... 16.2 C ap t i a n..L i j_a h s...._...... -.................. Owner Addre s a Cash 's__.Trucking Inc: „PO Box 7 , Yarmout port 02675 Installer Address d Type of Building Size Lot............................Sq. feet U DwellingNo. of Bedrooms............................................Ex Expansion Attic— p ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers 0.ai —Type g -------------•-•------------ P ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------•---•-------------------------------...--------------....------------------------..........----...........---- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length............... Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.....................................-.................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ 04 ----------------------------------------- .------ -.............. -------------------------- •---------- -- ----------.....-----......--------- . •......... O Description of Soil......................................................•.........................-----------------------------------------------------------------------...------------. x U --------------------------•-----------------------------------------•------•-•---•-------.....--------------------------•------------------•------------•---...........-............................... w U Nature of Repairs or Alterations—Answer when applicable......Addition of 1 1000 gal . l e........n g Pit___with two foot of stone. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by t e boar of health. Signed .... -i----------------------- ---------------------------------------- Da[e ApplicationApproved By - ...................... .............. .. .... ------ -- -- .----------------- --......... .---...-- ---------- Dace Application Disapproved for the following reason - ------ --- --------------—--------- . .......................... ....------ -------------------- ..................................................- -- -------------------------.---. --..............-- -- ---------------------------------- (� Issued Dare...... Permit No. -6- --- ------------------------------ ` are t 4 No.�v ._�._.... Fx$_. 3 0 _0 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appl ration for Disposal 18orks Tonstrnrtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: � e V �� 1 �a r;�.)t j an Ti, Iahs �• Tot 423 Location-Address or Lot No. --Choi 1 a r?Q a n r7 r a a --- zl L i-)a h s . - --- - Owner Address TruCki.nu_-TnCs ........................ PO -Box 7, Yarmouthoort 02675 Installer Address UType of Building Size Lot-------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) --Cafeteria ( ) 0 Other fixtures -------------------------------------------------------------------------------------------------------------------- ------------------- DesignW Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid"capacity............gallons Length---------------- Width---------------- Diameter----------------Depth---------------- x Disposal Trench—No--------------------- Width.................... Total Length-------------------- Total leaching area-------------------- ft. Seepage Pit No-----------_-------- Diameter.................... Depth below inlet-------------------- Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------_------_--------------------------------------------------- Date---------------------------------------- 4 Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ 1-4 G4 Test Pit No. 2................minutes per inch Depth of Test Pit_-__-...____....•_-- Depth to ground water._-..._..._-___.___....- a ------------------------------------------------------------------------------------------------------------------------------------------------ - 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ W V -----------------------------------------------------•-------------------------=----------------------------------------------------------------------------------------------------------------- W U Nature of Repairs or Alterations—Answer when applicable..---_Addition of 1 1000 y a 1 . l e a c h i n g / Pit with two foot of stone. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar&of health. Signed----A� Z� A- _ . /� Dm Application Approved BY --• - ----------------------------------------- J ✓'`--�---1----......-----�-----�----'.._---------- Date Application Disapproved for the following reason--------------------- - �..��..�C>/--- ----- Dw Permit No. ----------------------------- Issued ____________ _ ------------------------------------------ __ �1I_�� r Nate - L.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cgertifindr of (;E mplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System-constructed ( ) or Repaired ( XX ) by---------Cash's_ Trucking Inc. PO Box 7 , Yarmouth, Ma 02675 ------- --------- -- --------------- ----- ---------- -------------- ------------------------------------------------------ Installer at .........162_....Capt- l n Li-jahs Road ------ ------ ----------------------------------------------------------------------------------------------------------------------- -------------------- has been installed in accordance with the provisions of TITLE 5 of The State�Environmental Code as described in the application for Disposal Works Construction Permit No. �1 .. ---------- dated __________________-_-______.._._._...._._--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /-. DATE - ------------------ Inspector.-=- _�-�--- -/._, ------------ 1 y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �)o J TOWN OF BARNSTABLE Disposal Works (9unlitrnrtiun jrrmit Permission is hereby granted...._Cash' s Trucking Inc. to Construct ( ) or Repair ( X j an Individual Sewage Disposal System at No.....162......Caotian Li jahs Road, Centerville _ i"-(q -------------------------- '••, - - / as shown on the application for Disposal Vhorks ConstructionPermit Street � No ------------ Dated------------------------------------------ ------------------- Board-of IiealtL DATE--------------- ' -•f--�-------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS t _ TOWN OF BARNSTABLE 4 LOCk�70'N II 4eeV. ,a d5 .0ri,;Je SEWAGE # ASSESSOR'S MAP& LOTS._ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY .10p-o A Aa. LEACHING FACILITY: (type) � 'X`�� t (size) NO.OF BEDROOMS A BUILDER OR OWNER--� T22,010,d1VZ? PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: - Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f 1 hing ciL� Feet Furnished b � w o �. TOWN OF BARNSTABLE LOCATION �� ,�,�'>Q� SEWAGE # Y� VILLAG ASSESSOR'S MAP & LOTV�1,4'— INSTALLER'S NAME 6z PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size `� X C7 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER �J� 1 DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No _ _ _ .r � : . . .r'.,. F .�..�`� �•.e;,. �''.ti -.�K�y_� `, ' L • s . t F • �(S 9 t , S: e �. y� _fir �+ I 'Y � _ _ _ il No.Tl ....Y. F� 7.. ."—`. THE COMMONWEALTH OF MASSACHUSETTS ` BOAR® OF HEALTH ....... ....................OF....... l ,r.nS. 4s.1? G...--------- Allp ira#ion for Biopoii al Works Tont3trortion Errant Application is hereby made for a Permit to Construct ( ) or Repair (x') an Individual Sewage Disposal System at: ................-........-...................................................................... _---•••----------------•-•---.....-•--_-•---------.........------...----------_--•--------_-•----- _ Location-Address or Lot No. ...............�� -`�.....-�_42 Cn.1PiJ-1A..-•----......--------•--•--------- ... ................................. Osta l r l�sf � .u1fs; Address ................................................. ... r -------- Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................�z5c� _-------____-__-Expansion Attic 4) Garbage Grinder �/o) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ......................•••-•..... - W Design Flow................................. 5...--gallons per person per day. Total daily flow__-_____-__----_----.'Q0.........gallons. Cd Septic Tank—Liquid capacity............gallons Length.............•.. Width................ Diameter................ Depth................ Disposal Trench—No...aa r s,.......... Width ............. Total Length....4j:!........ Total leaching area__34-.n......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by._ 3:cphe-o-_.A._.I�i.l !/_ A� sa�'. f�Y ... Date.__.."//Z�%----------------- Test Pit No. 1.............minutes per inch Depth of Test Pit____1_41..T...... Depth to ground=water----- ............... Test Pit No. 2.....•:n7'...minutes per inch Depth of Test Pit....I.!s........ Depth to ground water-..____ ...... i.P'�I}.�:z ` lroam. Ss�k c�-tl:-? ?� insc:._ , e--- n,acQ..�t�= :_ ��k �qss� O Description of Soil.fcrsc_.��_5!lkf lvrrtes�.mil_-19F}{�r1�4r -- __ r�r►cQ.-- .ru4xl---kaj.+1'................. TEP EYv c1k35 s_..s!.lt-jt l �. urteS a T1Z i -'� �'¢a.m ub��n_t.�_ _ C�.-7 .. - Denim---••-------• `^ W Inz u p fr>,e a..�•Q..s1I 3 7b�1:49..*l��nsc ►nrc gum_ �1, 1._;. _m�cl( _thm ` . -s�'a+ ..... 1L�C2ty_ `, coU Nature of Repairs or Alterations—Answer when a hcable._.._(�'e. [� c..__. Aa_.stcl '!at_ _______-___ No 30216 Q C�_ysf?�vIS_...lnS-e_ sA Sre21 .�f --------------------- -- -- Agreement: /0 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac don Wwith�c.�d�a' the provisions of i T T L: p 5 of the State Sanitary Code— The undersigned furti:er agrees not to place the system in+4'8" operation until a Certificate of Compliance has been issued by the board of health. Signed.--------.. Date Application Approved By...... � -------- ------------ --- ..--•--f� -...4? ...... y Date 17' Application Disapproved for the following reasons:................................................................................................................ -•••-••--•-•....-••••--•-----•----•_-•••.....--•-•-•--•--•-•--------•----•----••••-•••----...••----•-•-•-••----•--------------••-------•-••-•---•-••••••-•-------•--••••-•---•••----•-••--•••-•••-----_- Date Permit No.........—I?CY 60•8_�-••-••--••----•-------• Issued..... ��- e?---------------- Date FxB............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a-.-0....................OF...... ApplirFa#ion for Diopooal Works Tontitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ..........................-...................................................................... --..........------•---•-•--•-••---••------•-----•-•---•---------•------•-•----......-•---•---•---- Location or Lot No.-Address .� . O5 rrcr� l�r� icy �/i...............J cash_. ..rn bu 1�.-••. .... :� -- --�......-- r....x J Ow�t Address W .�1.sc/Jrr-r.� ``1co� __._y y�y_7.C_/4'a0./:&-----------------•---------......----.....-------- ,-� rr................. T nstaller Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................ra .... .................. Attic (/�) Garbage Grinder (Va) Other—T e of Buildin a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .._... `l; O' W Design Flow................................. __.gallons per person per day. Total daily flow..............................._.._...._._..gallons. C4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter..._-______---.- Depth......_..._..... Disposal Trench—No. ..o"�......... Width.-._=?........... Total Length__..`01........ Total leaching area---34.d------ sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................. ft. Z Other Distribution box ( x) Dosing tank ( ) Percolation Test Results Performed by--- c1,Iu„ :_l.Ji I ...�LAAT�r2 r�� Date....°��!��Cy_ a Test Pit No. I............minutes per inch Depth of Test Pit..... �F�'s-___. Depth to ground water--------_ AA.q_ f=, Test Pit No. 2....... ...minutes per inch Depth of Test Pit-_.....4 _...... Depth to ground water. %0F.I�q_ �i 1 P O: ` i ^off-atZ_ 5�d� ai�°_2{ -- Z'�� ,c_ lr!6n.. �ld4c:G.!^�1: 1.. O Description of Soil.trcFc� 11 .;.S:�l1e_s 7Z 19'y �.. Cry �. >clttic ._ �: .1_..wL .............. ................STEPHEN x ?bcl��t "blt��ly. �lcmg co T _e 0-30" 4.c>,�ryta �y�/ a!�_`.J�j1_".7_ n �en5� X ALN c., `� , Wonct'` w +rt?cc. milt` 7u.t!1!gy_ f .c._i.iccf. rn-�y✓tr� `nullCO ... 11�CS........................ j yV1LSpN y U Nature of Alterations —�- A0 when Q - 9---- !n ..Sao bartk__ ._ _ ---- Agreement: A" The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac dance the provisions of'T'TLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed....................==................................................................. ---------•----••--------•------- Date Application Approved By•-•_ -•-•------------------------------------------- -•--- —`f------e--%,-------- Date Application Disapproved for the following reasons:--.............................................................................................................. -----------------------------•--•-----------•------•-------------•-•-------------------.....-------------•••-•-•--------•-------•••-•--•-•••-••---•••••• .................................. pQ Date Permit No........0.�: 1 � � �— ------�- --•---------------•----.... Issued- -----•-"--------------=--•--��....--•------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /r!!!r�...............OF.......... 2.r�tnl . . ..................................... Trrfif iraU of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired 'k—) by.................................................................................................................................................................................................... g In ler has been installed in accordance with the provisions of TITIE5 of The State Sanitary Code as described in,the application for Disposal Works Construction Permit No.. '24n. :.............. dated._...____.._._._...___._._...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..../� /'' � ',_' p ,- /l I✓?!1 Ins ector•-----••• .�"c,',� t .................... -v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. % 7.................OF........�� 11F...................................... — N 1 ...f. ...✓--.... FEE./.,! •-_. Disposal Work.5 Tontrudion amit Permissionis hereby granted...............---------------------------•------------------------------------•--------•------------•-------.....••••--..................... to Construct ( )er RFair '(j ) an I ividual Sewage Disposal System J at No. 0_f_....-'., •►T-e �...•.... l-v�^-e�9...... �±'`,.. ��.� _:: ...................................... Street t as shown on the application for Disposal Works Construction Permit No. .__ Dated.......................................... �_) ----------------------------- ••...... .................. .-•••-•--•••••-•-..... /� Board of HealthDATE -_� ". f.... ��.. FORM 1255 HOSES & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCAu1ON SEWAGE # VILLAGE aye, S DoYtT-- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE:NO. v SEPTIC TANK CAPACITY 1 LEACHING FACILITY:(type) vvL � (size) qb �(3`,�3 NO. OF BEDROOMS "1 PRIVATE WELL O UBLIC D WAT _�BUILDER OR OWNER ENE T0'21�(�\�.�-- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t j0-t)9A NI N f ,S��pClc.�aNiC o �, I � I t K %.. . DATE7/00 :_3 ---- ___ PROPERTY ADDRESS: 309 Green Dunes Drivp_ West HyanntlaoL,______ -- Mass,_43�ZZ.----------- On the above date, I Inspected the septic system at the above address. This .system consists of the following: 1 . 1 -1500 Gallon septic tank. 2. 1 -Distribution box. 3 . 1 -Leaching trench. 3 'x3 ' x40 ' 6 ;ed on my Inspection, I certify the following conditions: 4. This is a itle five septic system. ( 78 Code ) _ 5. The septic system is in proper working order` y �� at the present time. 6. The leaching trench is dry at the present time. 7. Pumped the septic tank at the time of inspection. SIGNATURE:,fV714h N a m e:_,L._ ,-AossmILa tom'-+------ Company: Jose,ph_PL Hacomber & Son, Inc . Address Box_66 CentervilleL Ha ._02632-0066 Phone:___508 775_3338_______ THIS CERTIFICATION ODES NOT CONSTITUTE A GUARANTY OR WARRANTY J:6SEPH P. MACOMBER & SON, INC. anks•Ceupools•Leachf lelds 33 Pumped Installed Town Sewer Connections 66 5.Centery lie. M 1026312-0066 3a RECEIVED MAR 2 12000 TOWHEALTH DEPT. COMMONWEALTH OF MASSACHUSETTB r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTN ENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (517) 292.6600 TR VD Y Seu ARCED PAUL CELLUCCI DAVM B. STF Governor CoS..Tr:fJ SUBSURFACE SEWAGE DISPOSAL SYSTFBA•YISPECTION FORM PART A CERTIF9CATION Property Address:309 Green Dunes Drive Name of o,~Jean Turbull West Hyannispport Mass. Addre"of Ownwt 13ox 90 Darteofinap.ctior+: 3/17/66 Wes Hyannisport,Mass. 02672 Name of Irupocuw: (Pte.sse Print) Jose—p h P_M a C O m e r r. I am a DEP approved sywwm kus, tdl pursuant w Section 16.W of Thte 6(310 CUR 15.000) company Narrm: J P Macomb r P. Snn Tnr_ µ iang Addnsa: 02632 Te4grtone Ntrntw508-775-3338 CERTIAG1TtON STATEI~1ENT I cartffy that I have personally Inspected the sewage disposal system at this address and that the Information reported below Is trus. accurate and complete as of the time of lrupection. The inspection was performed based on my training and experience In the proper function snd maintenance of on•sheWP.3&63 ewage disposal systems. The system: Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails tnspertols Slgrvnxe: /� -,'.Y' � Darts: The System Inspsc hall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wftNn thirty (30) dayr completing this Inspectlon. If the system Is a shared system or has a design now of 10,000 gpd or greater,the irupodlor and the system ow shall submit the rs90n to the appropriate regional oMce of the Department otrEnvironmems!ftotectlon. The original sho.Adbe ssnt to-To system owner and copies sent to the buyer, It applicable, and the approving authority. NOTES ANO COMMENTS revised 9/2/98 Page Iof11 �� hinted on lt* c. paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r , PART A CERTU`ICATION(continued) Property Address: 309 Green Dunes Drive West Hyanni sport,Mass. Ownir. Jean Turbull Date of leupection:3/17/00 INSPECTION SUMMARY: Check A, A C, " D. .. f A. SYSTEM PASSES: f'Jrl I have not found any information which Indicates that any of the failure conditions described in 310 CMR 11.303 exist. Any faaurs criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: Aj, One or more system components as described In the 'Conditlonal Pass'section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yea, no, or not determined(Y. N,or ND). Describe basis of determination In all Instances. If'not determined',explain why not. The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)Indicating that the tank was Installed within twenty 120)years prior to the date of the inspection: or the septic tank, whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exfihration, or tank failure Is Imminent. The system will pass Inspection If the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstrucud pipe(•) or due to a broken, settled or uneven distribution box. The system will pass Inspection If(with approval of the Board of Health). broken pipe(+)are replaced obstruction Is removed distribution box Is levelled or replaced AV - The system fsquired pumping-more than'fourtfines yeardue to broken or obstroeted pipe(•). The iystsm Inspection If(with approval of the Board of Health): broken plpe(s) are replaced obstruction Is removed revised 9/2/98 Page 2of11 Vr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ProvertyAddre": 309 Green Dunes Drive West Hyannisport,Mass. owns: Jean Turbull Date of Inspection: 3/1 7/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: —3 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.YALL.PROTECT THE PUBLIC HEALTHAND SAFETY AND THE 8[1f1BONMENT: a Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WiLL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM is FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ,Vj The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the p sence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance 40V _(approximation not valid). 3) OTHER AM revised 9/2/98 Page 3oru I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 309 Green Dunes Drive West Hyanni sport,Mass. Owner: Jean Turbull Date of Inspection: 3/1 7/0 0 D. SYSTEM FAILS: You Indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No „ Backup of-sewage intofaciR"-setern component due an overloaded orebggedBAS•or•cssspool. •1--"' ' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool O� Static liquid level iinthediptrib til n box tabove putlgt jpve-rt dqy to an overloaded or clogged SAS or cesspool. Liquid de/ptshiiin aeeopeeIs less than 6" below Invert or�available volume is less than 1/2 day flow. Required pumping more than 4 times in the lest year NOT due to clogged or obstructed pipe($). Number of times pumped 4•. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy Is-within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of wall water analysis for •►coliform bacteria, volatile organio•compounds, ammonia nitrogen-and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems In addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes N the system is within 400 feet of a surface drinking water supply / the system-ie-within 200 feetof♦tributary tom surfaoedrirt{ciwg watar+u'pIY- - • -- •• (/ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infognation. revised 9/2/98 Page 4of11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Add,ass:309 Green Dunes Drive West Hyanni sport,Mass. Owns,: Jean Turbull Data of t►tsp"k-3/1 7/0 0 Check If the following have been done:You must indicate either"Yes'or"No" as to each of the following: Yes No , Pumping information was provided by the owner,occupant, or Board of Health. None of the systemsornpoaents hare:baaa iswnped4opetJeasttwowowwandthe'trystem hasbeaoaocat wsomal Aow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was Inspected for signs of breakout. _ All system components,�luding the Soil Absorption System, have been located on the site. J/ _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was Inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on:- — Existing Information. For example, Plan at B.O.H. f� _ Determined In the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable) 115.302(3)(b)) _ The facility ownar(and.occupo.'■,R difteraot lrom.o nar).yuerstpraYldad.with t^rortna*toacn tkw p`por was„*a. If SubSurface Disposal Systems. revised 9/2/98 Page Sof11 I r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddr—: 309 Green Dunes Drive West Hyannisport,Mass. Owner: Jean Turbull Date of 1"spectio": 3/1 7/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: Ild �(d83ig : m. Number of bedroomsNumber of bedrooms(actual)l Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) jKs or r�:_, If yes, separatsImpaction.required - Laundry system Inspected or no) Seasonal use(ye Water meter readings,if available(last two year's usage(gpo): Sump Pump(yes or no): Last date of occupancy:&K COMMERCIAL/INDUSTRIAL Type of establishment: Design flow: AIA gRd ( Based on 16.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present: (yes or no). Non-sanitary waste discharged to the Title 5 system: (yes or no),4 Water meter readings,if available: Last date of occupancy:-&& OTHER:(Describe) Lest date of occupancy: ` GENERAL INFORMATION PUMPING R CO .S and sourrA of informat , — t /Y`l �Pill� �Lt11P�9 JX/�Jrs1�.�� ►•�L� System pump d as part of ins action: (yes or no) If yes, volume pumped: allons Reason for pumping: TYPE OF 'STEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract A,j Tight Tank AM Copy of DEP Approval Other UROXIMATE AGE of all com onents, date tallod,40 known)-and source ot4nformation: 3-z19s � P 967- Sewage odors detected when•arriving at the site:(yes or no) revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirwed) Property Address: 309 Green Dunes Drive West Hyanni sport,Mass. Owner: Jean Turnbull Date on: 3/17/00 BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction:_cast iron_t/40 PVC_other(explain) Distance from private water supply well or suction line / Diameter� Comments: (condition of joints, venting,evidence of leakage,-otc.) Joints appear tight No evidence of 1 akage SEPTIC TANK ,ri (locate on site plan) /f Depth below grade: Material of construction:_J!!�oncrete metal FiberglassAlLPolyethylene,!!/jeother(explaln) If tank is Instal,list age yZ4 Js.agee.c)onfirmed b Certificate of Compliance(Yes/No) Dimensions: �06'v,/ �r4 ��eCJt ��7r/l�ifJ Sludge depth: 7 a Distance from top of qudge to bottom of outlet tee ortaffia Scum thickness: Distance from top of scum to top of outlet tee or baffle: 0 Distance from bottom of scum to bolt of outlet ee or baffle. a How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structuroHntegrity, evidence of leakage,etc.) Pump the septic tank every 3 years _ fTn1 cat R outlet teps arp in =1 anp The tank is structure-Illy Sound and GREASE TRAP: f (locate on site plan) Depth below grade:Material of construction.f/dconcreta4metal4AFiberglass��Polyethylena Aother(explain) Ad Dimensions: Ad Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle:-" Date of last pumping: N1* Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is nnf- present revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(coert4wed) P.ope.tyAddr"S: 309 Green Dunes Drive West Hyanni sport,Mass. Owrw: Jean Turnbull Date of lnspsetion: 3/1 7/0 0 TIGHT OR HOLDING TANK:UA/C-(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: A//9 Material of construction:.V,4concreteAlA metaWj4FlberglassAJ4Polyethyion*A other(explain) A14 AAA Dimensions: AM r Capacity: AM gallons Design flow:_ ;0,4 gallons/day Alarm present—Aa Alarm level: /J.4 Alarm in working order:YesW,4 No,&# Date of previous pumping: A_ Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tiqht or holding tanks arP not =rPgPnt DISTRIBUTION BOX:z (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) — — Distribution hnx hag nnP latpsal No evidence of solids carry cover. No evidence of leakage i ntn nr c),tt- of the bay PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No)N,4 Alarms in working order(Yes or No)-Ad Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump chamber is not nrRRPnt revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTUA D7 SPECTION FORM t: PART C SYSTBA WFORhAATION(cont&tued) PropeMAddreas: 30.9 Green Dunes Drive West Hyanni sport,Mass. D1 rw: Jean Turnbull Data of lnapectiort: 3/1 7/0 0 SOIL ASSORPTION SYSTEM(SAS)` (locate on atte plan, If possible;excavation not required,location may be approximated by non-Intruslve methods) If not located, explain: Type: leaching pits,number:_ leaching chambers,rwmber:� leaching gallerlss,number:—M, leaching trenches,number,length. !r leaching fields, number, dime Ions: overflow cesspool,number: l Alternative system: Name of Technoioyy; Title Five ( 78 Code Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soli, condition of vegetation, etc.) Loamy sand to mpdiiim fine canH Leal Veaef CESSPOOLS: (locate on site plan) Number and conflgurstion: Depth-top of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: 41,4 Dimenslohs of cesspool: Msterlals of construction: Indication of groundwater: f inflow(cesspool must be pumped as pan of Inspection) • Cesspools arp not e rpspnf- Commenu: (note condition of soil, signs of hydraulic falluro..level of ponding,condition of.vegetation, etc.) a- Cesspools 7Le not z rpspni (locate on alu plan) Matedais of construe qn: �� Dimensions: Depth of soUds: Commenu: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) revised 9/2/98 Paer9orii SUBSURFACE SEWAGE DISPOSAL DYSTEM INSPECTION FORM + PART C SYSTEM INFORMATION(ea*wed) PiopenyAd&—:309 Green Dunes Drive West Hyanni sport,Mass. Owrw: Jean Turnbull Date of kmwec`w: 3/1 7/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes Into house) • I 0 revised 9/2/98 Page 10of11 R SUBSURFACE SEWAGE DISPOSAL SYSTEM'NSPECTSON FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Green Dunes Drive West Hyanni sport,Mass. owner: Jean Turnbull Date of Inspection: 3/1 7/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater AV/-Feet Please indicate all the methods used to determine High Groundwater Elevation: �btained from Design Plans on record Observed Site(Abutting property)observation hole, basemeat sump etc.) determined from local conditions _L�/Checked with local Board of health Checked FEMA Maps _ZChecked pumping records --Z/Checked local excavators, Installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 i TOWN OF BARNSTABLE � � I LOCATION W*—s &SEWAGE i VILLAG r, �1 k ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. i SEPTIC TANK CAPACITY - �,� ( X L3 LEACHING FACILITY:(type) — NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Z .01 DATE PERMIT ISSUED! v- I ol DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No Y .: 14; 1 • I 1 1, I r I i I'd: ..'".Lb8'ON �ti I�NdN I d Sf l�l�l I� -rlhEw�:ni HUX Wd6S:2 T 0002'2 J y ''T.T TI�Rt'�l�TT.TT.-JR,•l.T.RI�"l.R i1R.l'RT11r,rT►J1T7f•11T/fi'A{7J1'ft'fT�I AT T7PT1•T�11-TI"'...�.,�..,` TOWN OF Barnstable BOARD OF HEALTH J 0 SUI)SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I •••Tt't•T••. .• -T.tiT.•'.�TT11tT�1'R.T•IT`RrllTfftf'7tT'r•t•TT•1tRR11It�-TAR.OA►/�1�IIR�R!'At7 tRR !.TI'T'T.•T.-..^ -TYPO OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 309 Green Dunes Drive West HvannisDort,Mass ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Jean Turnb-ull PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Salf 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632, Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate , and omplete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : ��System: PASSED - The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 6 , 3.10 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . "r - Inspector Signature Date anecopy of this certification must be provided to the OWNER, the BUYER here applicable) and the BOARD OF HEALTH. * If the inspection FAILED, 'the owner or.".op operator shall u p pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 15 . 305 . partd .doc R'T1.)(Y) .Kko, mon- ( Gtociti-tc Vc.rtIta.1 t-mivM N.Ca.V,D 1 I� Ilr�JT 11'A / �1�1 Q t�s IGN ��RTq I 4__bccfroom -stn Ic mtl: ✓c> arbor c- 1`I✓iC�Cr CATS ; a1/7/8 9 I �q4 .. .. _. EST 8 : S.A. 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